Evaluation of Chest Pain in the Emergency Department

We read with interest Kaul and Abbott's recent editorial on evaluation of chest pain in the emergency department [1]. We have been applying these methods at William Beaumont Hospital for the last 2 years [2, 3]. Patients presenting to our chest pain clinic are immediately evaluated by a team of emergency physicians, cardiologists, and specially trained nurses. Patients with definite evidence of acute coronary ischemia are immediately triaged and treated. Those whose chest pain remains unexplained have radioisotope single-photon emission computed tomographic imaging in the emergency center with Tc-99m sestamibi using a dedicated γ camera. The resulting images are immediately sent by computer network to a nuclear medicine physician for interpretation. Thus, 24-hour coverage is provided.